Sleepless nights can be triggered by countless factors, but by controlling confronting the issue head on, practitioners are able to gain a better understanding of what causes them. By Nicholas Saraceno

As the old saying goes, time flies when you’re having fun (or sleeping for that matter). Unfortunately for some, this is not always the case. According to the American Sleep Association (ASA), 50 to 70 million adults in the United States have some sort of sleep disorder. These disorders can range from dyssomnia’s to parasomnias.

Often times, this inability to rest results in sleepless nights. Although there are a plethora of causes linked to difficulty sleeping, integrative practitioners are able to pinpoint the most popular ones, while finding potential solutions.

Causes & Common Conditions

As previously mentioned, the causes that influence the lack of sleep are numerous, but doctors and experts alike have been able to narrow these down to ones backed by science, such as brain function, which could be the root of the problem.

“There are cycles of sleep: rapid eye movement (REM) and non-rapid eye movement (non-REM),” said Jeremy A. Holt, associate director of Ajinomoto North America’s health services section in New Jersey. “REM is typically 25 percent of the sleep period. Non-REM is divided into four stages. Stage One is the period between being awake and falling asleep. Stage Two is the onset of sleep and becoming disengaged from your surroundings. Stages Three and Four are the deepest and most restorative sleep, where muscles are relaxed, blood pressure drops and breathing becomes slower.

“A restless sleeper will wake up while transitioning between these stages. Once the body wakes, it doesn’t return to the state it awoke from – it must go back to stage one. Continually waking during the night and not reaching Stages Three and Four is what causes poor sleep quality.”

However, lack of sleep can also stem from gender-related issues that interfere with the REM process.

Gina Besteman, RPH, is the director of compounding and dispensing at the Women’s International Pharmacy in Wisconsin, a compounding pharmacy that provides high-quality bioidentical hormone therapies.

“One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect sleep,” she noted. “Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. Its’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea. Estrogen’s role in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin and acetylcholine in the body. Estrogen has been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs and increase total sleep time. Low estrogen levels may lead to hot flashes which can also affect sleep.”

Perimenopause refers to the menopausal transition, normally occurring in a women’s 40’s, sometimes mid-30’s (mayoclinic.org). Dr. Besteman also cited that if there is a disruption in cortisol, the stress hormone produced by the adrenal glands and melatonin, the hormone responsible for sleep and wakefulness manufactured by the brain’s pineal gland, these could be contributors to the issue.

As a result, different sleep conditions affect different societal demographics. According to Svetlana Kogan, MD, an integrative doctor in New York, NY and author of Diet Slave No More!, individuals affected by difficulty sleeping can be broken up into three categories.

“Young people have over stimulated nervous systems due to cell phones, video games, computers, TV and other electronic gadgets,” she said. “Older people (ages 35-60) are having difficulty sleeping due to all of the above, plus the stress of having to balance family, children and work. Much older people (over 60) have physiologic issues during sleep that cause them to wake up many times during the night (urinary incontinence or frequency, sleep apnea, insomnia, pain syndromes). Overall, people who live in big cities sleep much less than the rest of the country. This could be due to overstimulation of the nervous system, work stress and lack of time spent outdoors (that is, less oxygen to the brain).”

Solutions to Better Sleep

After hearing of patients’ difficulty sleeping, the next question is: what exactly can practitioners recommend to their patients to help combat these issues?

A great starting point would be in the mineral magnesium, which notably has a calming effect to it.

“Magnesium is an essential electrolyte and is known as the anti-stress mineral, and is a natural sleep aid,” mentioned Carolyn Dean, MD, ND, advisory board member of the Nutritional Magnesium Association. “Numerous Studies have shown its effectiveness in reducing stress levels as well as helping with deeper more restful sleep. This mineral has been depleted from our soils and foods due to modern farming methods and food processing. More than 75 percent of Americans do not get their recommended daily allowance of this mineral, which is a co-factor in 700-800 enzyme reactions in the body.

“A magnesium deficiency can magnify stress because of serotonin, the feel-good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function. Not all forms of magnesium are easily absorbed by the body. Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day.”

As another option, Boiron USA, a Pennsylvania-based manufacturer of homeopathic medicine, offers Quietude, dissolvable tablets that help target lack of sleep, without the effects that come with it. Christopher Merville, DPharm, director of education and pharmacy development at the company, explained how exactly the medication is effective.

“Quietude temporary relieves sleeplessness, restless sleep and occasional awakening without grogginess or risk of dependency,” he said. “The biggest advantage of this sleep aid is that it doesn’t knock you out. It may sound funny for a sleep medicine to be non-drowsy and non-doping, but this means you won’t have that groggy hangover effect the next day like you are still in a fog, which is typical with sleep aids that mask the problem by sedating you. Instead, Quietude helps and overactive mind calm down. It’s perfect for when your head hits the pillow but you keep going over that to-do list or replaying the day’s events. If you’ve had a particularly exciting day- whether it’s from good or bad news- prepare for bed by taking Quietude once in the early evening and then again at bedtime.”

A common trend among those struggling with sleeplessness is the fact that the body, especially the brain, is operating at full capacity even during the late evening hours, when it should be resting. Glycine, and amino acid found in Ajinomoto’s Glysom, is able to affect he body accordingly.

“Glycine is a naturally occurring amino acid that induces sleep by setting the body’s internal clock and reducing the core body temperature,” said Holt. “It signals the body to relax and prepare for a better sleep cycle, improving the body’s sleep architecture. Taking Glysom together with melatonin provides a combo effect- the melatonin helps you fall asleep, the Glysom keeps you asleep.”

State of the Market

Being that difficulty sleeping is an ongoing issue, there are positive strides being made in the market, precisely in terms of both traditional and natural medications respectively. In fact, a major contributor to traditional medicine’s success is the severity of the conditions that it treats.

“Insomnia is recognized as the fourth most prominent health issue just behind stress,” said Dr. Dean. “The projections for sleep aids for 2018 are approximately $732 million with a 27 percent category growth rate. The recognized drawbacks are side effects and addictive nature of these medications.”

Moreover, as Dr. Kogan stated, “the sales are unprecedentedly high- especially those of generic sleep meds, as they are cheaper.”

On the other hand, natural sleep medication has continuously garnered attention, partly due to individuals that are popular in the public eye. “Awareness of the importance of sleep an getting proper sleep is growing, and with high profile celebrity deaths (Michael Jackson, Prince) related to sleep issues, consumers are searching for and demanding natural alternative to otherwise harmful side-effect ridden medications,” added Dr. Dean.

As a result, being that pros and cons lie in both forms of medication, practitioners must fairly provide both options to their patients.

Research

There are endless questions surrounding sleep, such as what in fact is the best solution to a good night’s sleep and how one gets to that point. Progress has been made in this regard, and to further enhance this progress, practitioners are thinking out of the box with their interest in research.

In fact, she is quite fond of this delivery method, as it takes more of a holistic approach to medicine. “Self-hypnosis (which I admire) is the least popular method because it’s an acquired skill that needs to be rehearsed many times over, until it becomes a lifestyle,” she mentioned. “Teaching patients self-hypnosis is my favorite modality, because it empowers patients to tap into their own inner resources, instead of depending on pills.”

Although the medical world may not have received all the answers is has been looking for thus far, one ideas is for sure: good sleep is king.

“There is a much greater understanding of the overall physiological and emotional role sleep plays on a body’s health,” said Holt. “Polysomnographic studies have proven that there is no substitute for good sleep. If a body is deficient in vitamin C, a supplement will help adjust that. The same cannot be said of sleep deficiency. Lack of sleep affects the whole body, including metabolism. That’s why good sleep is so important for weight loss.”

Coping with emotions is a must for a healthy lifestyle, combined with all the rest: healthy diet, physical activity, adequate sleep, fellowship and socialization and mental stimulation. Unfortunately, far too many attempt to dismiss and ignore the emotions of others along with their own. The sad result is multifold, from perfunctory existence to downright impairment; from the walking wounded to the psychiatrically hospitalized; from the irritable and lonely to the depressed catatonic.

I take issue with the idea that EI is actually a construct of intelligence; I don’t think it is, nor should it be. Unfortunately the term emotional “intelligence” has muddied the waters of our thinking but I do understand the parallel to cognitive intelligence. What Dr. Daniel Goleman seemed to be saying in his book, Emotional Intelligence, is that there are levels and layers of emotional achievement just as there are with IQs. But emotions are quite different from intellect and arise from different areas of the brain, so let’s separate them for the sake of the discussion.

My definition is short and perhaps too brief but I believe it is the source and therefore holds the most importance. Emotional intelligence is the courage to pursue self inquiry. From that critical examination of self, you can extrapolate to the outer world in growing concentric circles and include family and social relationships, work and school environments and basically anywhere one person interacts with another. The heart and soul of emotional intelligence is personal communion with self and interaction with others and how that proceeds. Such discussions inevitably get into the nurture vs nature argument or in this case, trait vs ability. Perhaps those who do the best job of exhibiting this quality are those with both, a genetic endowment, if you will, which then may facilitate the development of the ability. I believe it is part gift and part achievement, but I do believe anyone can learn how to accomplish it if they set their mind to it and are willing to take that hard look.

Empathy is the cornerstone of emotional intelligence. My personal experience supports the “trait” theory because as a young child, I was acutely aware of other people’s feelings and had no such role modeling in my own family. If there was a negative in my early experience, it was that I focused too much on the feeling of others to the exclusion of my own. As an only child, I did have the alone time in my tree house to make up for it and spent a lot of time in introspection. It probably didn’t help to constantly have my grandmother remind me that “children are to be seen but not heard!” That message assigned me to be the proverbial “fly on the wall,” observing the world as it went by without giving back much input. I struggled with insecurity as a teenager and never felt my own voice was wanted or needed in the crowd, even though I enjoyed formulating my own opinions. I lacked the confidence to speak up around others and maybe by default became a really good listener.

It wasn’t until I went to nursing school that the empathic me blossomed into the person who not only felt the struggles of others but also was able to actively care for them. As you can well imagine, this filled me with immense satisfaction and I began to use my voice to influence and guide the emotionally challenged. I can easily see how the topic of leadership enters this sphere of discussion. It is just common sense that those who can fully engage with the emotions of other people will ultimately make the best leaders. First comes the awareness which requires a close scrutiny, utilizing those techniques we learn in school like keying into facial expressions, body language and tone of voice as well as signs of anxiety and discomfort. Next comes the interpretation and formulation of the problem, followed by the execution of the plan to assist.

But before you can help others, you must help yourself. It may sound like an easy task but it’s not and for many, it is simply too scary to peer into their own souls. Everyone has one degree or another of emotional pain and all we have to do is look around to see how people fail to cope, drowning their perceptions in alcohol and drugs or violent outbursts towards others like road rage. On the flip side are those who choose to ignore emotions altogether and they manifest it by affective flatness and avoidance of closeness with others. On either side of this spectrum, the person becomes absorbed with self and that preoccupation with self to the exclusion of others is the death knell for emotional intelligence. Is this a terminal condition? I don’t believe it is but those with narcissistic traits and other personality dysfunctions will have to work much harder than those who are naturally empathic to improve their ability to relate to others. Professional assistance is highly recommended.

This is a fascinating topic to be sure and a critical one in relationships that require maintenance and repair just like your vehicle. I have often read that couples that can argue ultimately do much better than those who are avoidant but cordial. The word “argue” conjures up visions of loss of control and throwing lamps across the room but it doesn’t have to be that way at all. A couple can have a civil argument to discuss differences or problems without doing something they regret. We all say things we regret; it’s just part of the human experience and hence, the importance of the phrase “I’m sorry.” In my experience, the single greatest factor preventing such open discussion is the fear of loss of control. One simple remedy for this fear is acceptance of one’s frailties as a human, giving yourself permission to feel and experience the full range of emotions, including anger. As my therapist states so beautifully in my paraphrase, one must be willing to welcome, examine, undress, lay bare, and do battle with our emotions, both positive and negative. Without doing so, we will never experience the richness and the joy that life has to offer. Nor will we be able to get truly close to another human being.

Now, go look in the mirror and continue your journey of becoming an emotionally intelligent person. You will reap great rewards for yourself and those that you love.

As healthcare practitioners, our main goal is our patient’s well-being. In an integrative healthcare model, all practitioners, need to learn to work together for a common goal. Dental professionals need to educate themselves about different treatments and diagnoses that relate to the body as a whole. Medical practitioners need to educate themselves about oral conditions and diseases that affect the overall health of their patients.

Everyone needs to learn the potential effects of conditions and issues and how they interact to create dis-ease. There needs to be more sharing of information on the fine points of disease and conditions and the different treatments available.

From an oral perspective, dental practitioners must see their patients as a whole and realize that systemic issues and conditions can affect the health of the mouth and also that oral conditions can affect whole body health. We need to be more exacting in that relationship of how oral pathology can influence other organs and metabolic pathways, leading to systemic effects. We also need to learn to speak and communicate in ways that physicians and other medical providers can understand. One of the most beneficial things that dental professionals can do is to help inform and educate their medical, naturopathic, chiropractic and nursing colleagues in identifying and understanding oral diseases and conditions.

Medical professional also have a responsibility to help dental professionals understand systemic diseases and conditions. There are many ways that systemic illnesses can affect the health of the head and neck area.

For example, in considering the posture of a patient, the alignment of the body can affect how healthy and functional the mouth is. If the body is misaligned or canted, the occlusion or bite can be pathologic. This can affect the health of the tempromandibular joints. It can also affect the health and condition of the teeth, the musculature of the mouth and surrounding structures. Once the body is aligned, the mouth can be stabilized and vice versa.

We can also look at thermographic images of the body and see direct influence or connections between the mouth and body structures.

It is widely recognized in integrative medicine, that direct connections between certain teeth and body parts or organs exist. When a tooth is diseased, the corresponding body part can be affected as well.

When we look at the traditional training and education that we all acquired in dental and medical schools, we realize that we were all taught an amputation model of delivering care. We were taught that if we cut away disease, then health will appear.

As more open-minded professionals, we realize this model does not work well for most patients and only further prolongs their morbidity and possibly can cause a faster mortality.

It becomes incumbent on all health professionals to to educate ourselves and to find and help educate colleagues who are open-minded enough and willing to learn new modalities in order to work together towards common goals.

It is with great enthusiasm that ACAM announces that we have the
distinct pleasure to host Gervasio Lamas, MD to our upcoming Spring 2013
conference and tradeshow. Dr. Lamas will be speaking on Saturday, June
1, 2013 as a special lunchtime presentation during ACAM's General
Session proceedings.

Gervasio
A. (Tony) Lamas, M.D., is chief of Columbia University Division of Cardiology
at Mount Sinai Medical Center in Miami Beach, Fla. and author of the TACT trial
report. Dr. Lamas is the Chairman of Medicine at
Mount Sinai Medical Center and Chief of the Columbia University Division of
Cardiology at Mount Sinai Medical Center. He received his B.A. in Biochemical
Sciences cum laude from Harvard College and his M.D. with honors (AOA) from New
York University. He completed his Internship and Residency at the Brigham and
Women's Hospital of Harvard Medical School, where he later served as Assistant
Professor of Medicine. During the last decade, he
has enrolled thousands of patients in more than a dozen U.S. and international
trials in order to improve cardiac care and prevent death and disability from
heart disease. He served as Chairman of the Mode Selection Trial in Sinus Node
Dysfunction (MOST), a trial that led to profound changes in cardiac pacemakers.
He served as Co-Chairman for the Occluded Artery Trial (OAT), and Study Chair
for the Trial to Assess Chelation Therapy (TACT), a $30 million trial sponsored
by the National Institutes of Health. He has authored over 300 scientific
publications, and maintains an active clinical practice in Miami Beach and Key
Biscayne.

About the Conference

ACAM's Spring 2013 Conference and Tradeshow will be hosted at the
Westin Diplomat Resort in sunny Hollywood, FL Wednesday, May 29th -
Sunday, June 2nd.

ACAM will also be hosting its Certified Chelation Therapy Examination, is partnering with the Certification Board For Nutrition Specialists to host their examination, and will offer a multitude of bonus learning and networking opportunities.

Dr. Sushma Bahl will help you repair your health by restoring
balance between different body systems. Her cutting edge Functional
Medicine approach is to treat disease from the root cause by natural
therapies. Dr. Bahl specializes in Anti-Aging, Regenerative and
Functional Medicine and is certified in assessment and management of
Fibromyalgia by FACSUF.

Lyme disease is a chronic inflammatory condition caused when a certain type of bacteria, called Borrelia burgdoferi,
is transmitted by the bite of a deer tick or black-legged tick. Other
common infections transmitted by ticks—notably Babesia, Bartonella and
Ehrlichia—will very often contribute to the severity of the condition.
Although Lyme disease is easily treated in its early stages, the
condition is difficult to diagnose. This is due mainly to the wide
range of symptoms and to the poor reliability of lab tests that are
currently used for identifying the Lyme-related infections.

Lyme disease is the most common tick-borne illness reported in the
United States. According to the U.S. Centers for Disease Control,
annual cases reported in the nation more than doubled between 1991 and
2005. Again, however, most cases are likely to be missed and thus are
not reported.

Symptoms commonly linked with chronic Lyme disease include severe
fatigue and debilitating joint pain, which some physicians refer to as
"Lyme arthritis”. In fact, however, Lyme disease as a multisystem
disease that affects the entire body, including muscles, bones,
cartilage, brain, heart, skin, eyes, ears, head, neck, and face, as well
as the digestive, respiratory, circulatory, reproductive and nervous
systems. The symptoms of Lyme and other tick-borne illnesses can be so
diverse as to seem mind-boggling in complexity. For example, the
digestive problems can include diarrhea, constipation, nausea and
stomach pain, as well as symptoms of gall bladder disease. The
respiratory and circulatory challenges may include shortness of breath,
cough, chest pain, heart palpitations, night sweats, heart blockage,
murmurs and even heart attack.

Other signs of advanced Lyme and tick-borne illness include
unexplained changes in weight, repeated infections, increased allergic
reactivity, pain that moves from one part of the body to another, and
symptoms that come and go. For some people, the infection can lay
dormant for years and then manifest for no apparent reason. For many
others, symptoms manifest within a few months following the initial tick
bite—whether or not antibiotic treatment was received at the onset.

Because most physicians do not have adequate training in identifying
Lyme and tick-borne disease symptoms, the condition is frequently
overlooked or misdiagnosed. Moreover, because some Lyme-related
symptoms are psychological in nature—e.g., frequent anxiety, heavy
moods, poor concentration and short-term memory lapses—the condition
tends to be dismissed as being "all in your head.”

Insights from Dr. Pittman’s Recent Physician Trainings

At this writing, I now have over a decade of clinical experience
working with Lyme patients and have regularly attended the
International Lyme and Associated Diseases Society Annual Conferences,
the "Lyme literate” professional organization of which I am a member.
Beginning last year, I decided to intensify my training by participating
in one-on-one preceptorships in New York, considered "Lyme Ground Zero”
due to the enormous number of cases documented there. My mentors for
this training were two of the top Lyme-literate physicians in the world,
Dr. Richard Horowitz of Hyde Park and Dr. Bernard Raxlen in Manhattan.

These clinical trainings led me to create a three-week Lyme
Stabilization Program, which we have begun implementing at our
Raleigh-based Carolina Center for Integrative Medicine. The program
provides intensive nutritional, digestive and detoxification support in
preparation for targeted antibiotic protocols that include both
pharmaceutical and herbal antimicrobials. Our center is a full-service
integrative medicine facility that provides various intravenous (IV)
therapies, which are immensely helpful in stabilizing very ill
patients. Once stable, patients are started on antibiotics and herbal
anti-microbials, with many patients requiring IV antibiotics for
treatment to be effective. We have taken steps to make this approach as
cost-effective as possible and, to some extent, have been able to
maximize insurance coverage for our patients.

Upon returning from my recent clinical training with Drs. Horowitz
and Raxlen, I realized that many of us who have been treating tick-borne
diseases have overlooked a very basic detail: Treatment must be
specific for each stage of the life cycle of the Lyme organisms. After
being transmitted by the tick bite, the infectious agent actually
changes its structure upon reaching each phase of its life cycle within
the human host. Unless the antimicrobial treatments target each and all
of the life-cycle stages, the disease will persist and treatment
success will be relatively short-lived.

Another key insight concerns the severity of tick-borne coinfections,
especially blood parasite Babesia. Even though it is difficult to get
reliable test results on Babesia’s presence, we know that it is a very
common co-infection. Babesia is a very challenging organism to treat,
often requiring multiple anti-parasite medications as well as herbal
antimicrobials. My training up in New York also helped provide a
clearer understanding as to which patients need to be on antibiotics
early on (as opposed to trying the herbal antimicrobials first), as well
as which patients probably will never get better without IV
antibiotics.

Tools for Overcoming Lyme and Other Tick-Borne Diseases

The Carolina Center’s approach to treating Lyme and other tick-borne
diseases is grounded in principles laid out in the Physician Training
Program, sponsored by the International Lyme And Associated Diseases
Society. Our approach utilizes a combination of strategies that address
nutrient deficiencies, immune dysfunction and hormone imbalances, along
with the careful use of antibiotics, which serve as a first line
therapy and thus play a pivotal role in combating Lyme disease. Much of
the art of treating this condition is determining when and how to use
antibiotics, immune and hormonal support, detoxification, nutritional
therapies, and some combination of these options.

Antibiotics are always the first course of action for anyone who has
experienced a tick bite and now has acute symptoms of fatigue, body
pain, headaches, and generalized flu-like symptoms. Although Lyme
disease is easily treated with antibiotics in its early stages, if
undiagnosed until it has progressed considerably, then chronic symptoms
can develop. This more persistent form of Lyme disease obviously
requires a more aggressive treatment approach..

Other factors that affect the ability to recover from Lyme disease
include the following: treating the co-infections with other tick-borne
organisms as well as other organisms (bacteria, yeast or parasites);
removing toxic metals and other environmental pollutants that disrupt
the immune system; correcting cellular nutrient deficiencies that
ultimately compromise the immune and detoxification systems; and
addressing hormonal imbalances that are often due to Lyme-related damage
to the hypothalamus, resulting in numerous deficiencies.

The tools we embrace for treating Lyme disease at the Carolina Center
are designed to not only eradicate the infection, but to bolster
energy, sleep, mood, and overall functioning. These changes, in turn,
give our patients the sense of peace and control they need to fully turn
this situation around.

Treatment of the digestive system with a variety of nutrients
that improve absorption, bolster immune system functioning, and
restore the normal flora to an optimal balance.

Treatment of chronic gut infections, focusing on removal of the
"biofilm” that protects these organisms using a combination of
pharmaceutical and natural anti-microbial agents.

Promotion of elimination and detoxification through the use of colon hydrotherapy

Implementation of other detoxification techniques including
modified fasting, chelation therapy and glutathione therapy.

The use of hyperbaric therapy to promote cellular repair, immune system stimulation and detoxification.

The use of immune boosting pharmaceuticals and supplements
necessary for the body to ultimately control the infection when
antibiotics are no longer being used.

Note: For patients who have been on extended periods of
antibiotic therapy prior to being seen at the Carolina Center, we
often recommend a break from those treatments to assist with
improving detoxification, immune function and gut repair.

Our overall approach continues to be informed by
clinical trainings sponsored by the International Lyme And Associated
Diseases Society and through direct work with leading Lyme physicians in
the Northeast. Also, by affording increased antioxidant and
anti-inflammatory protection, the addition of specific nutritional and
herbal supplements can further improve therapeutic outcomes for Lyme
patients, as reported by University of California researchers in the
September 2009 issue of Evidence-Based Complementary and Alternative Medicine.

A Story of Hope: Janet’s Recovery From Lyme [Case of Barbara Miller]

Two years ago, a 56-year-old woman named Janet came to our Raleigh
office complaining of various symptoms that had progressively worsened
over several years. These included back pain, muscle weakness,
difficulty swallowing, fevers and sweats, numbness and tingling of her
lower extremities, shooting pains throughout her body, headaches,
dizziness, blurred vision, and irregular heartbeats. She has been to
numerous physicians, including three neurologists who claimed they could
find nothing wrong with her.

The relentless pain and discomfort took a toll on her normally upbeat
disposition. "The symptoms gradually took over my life,” Janet
recalls. "I became physically and mentally handicapped. Prior to the
diagnosis, I went through a long period of time where the symptoms and
intensity increased. It was both stressful and discouraging to be
passed along from one doctor to another without any positive results or a
diagnosis.” Three of her doctors had suggested that she see a
psychologist.

Her initial labs were strongly positive for active Lyme Disease and
she had a classic history of numerous tick attachments dating from
shortly prior to the onset of her symptoms. Prior to commencement of
antibiotic therapy, Janet underwent comprehensive testing to assess her
nutritional status and immune, toxic burden, detoxification capacity,
and other factors then treatments were employed to redress nutrient
imbalances and prepare her digestive system for antibiotic therapy.

We then started her on an aggressive treatment protocol that helped
her feel more at peace and in control. "It was a huge relief to finally
get on a plan designed to get my healthy life back,” says Janet. "Over
the past year I have worked with every person at the Carolina Center
and felt totally supported and encouraged. At this point, I have
greatly improved, and my attitude is once again positive. I am feeling
and functioning much better every day, and am deeply grateful to have my
life back.”

As of the spring of 2012, Janet was 75% better, with nearly all body
pain eliminated and most other symptoms resolved. However, she still
suffered from periodic dizziness, disorientation, and numbness and
tingling in her extremities—all symptoms attributed to neurologic Lyme
disease. At that point, we realized Janet was not going to fully
recover without antibiotic therapy that could penetrate the blood brain
barrier and reach the central nervous system.

We started her on a Lyme-specific antibiotic called Rocephin
(ceftriaxone), and her oral antibiotic regimen was adjusted so that all
life cycle stages of the Lyme bacteria were addressed. We also treated
her for the coinfection known as Babesia, which was strongly suspected
in her case due to her pattern of fevers and sweats. Janet immediately
noticed a more dramatic response to treatment. "I can feel this working
in my head like nothing else,” she said soon after starting the new
treatment protocol.

Though Janet did experience a brief worsening of her symptoms—the
Herxheimer or "die off” reaction that results from toxins being released
as microbes are killed by antibiotics—she is now stable and feeling
positive about her future. "I have begun to have days when I feel like
my old self more than ever,” she says. "It’s been a long journey, but
I’m feeling stronger and better than I have in a very long time.”

My hope is that Janet’s story will inspire other patients who are
striving to overcome advanced, chronic Lyme disease. Though her
recovery from this condition is ongoing, there is little doubt that she
has largely reclaimed her life and her health. At least some of the
credit must be given to her proactive attitude and willingness to
embrace a healthier diet and lifestyle, as well as the nutritional and
herbal supplement regimen to which she has been adhering. As she
continues to get even stronger, I expect that Janet will motivate others
with chronic Lyme disease to face their challenges with authentic hope
and with the conviction that they can, indeed, overcome this seemingly
intractable illness.

* Dr. Pittman is Medical Director of the Carolina Center for
Integrative Medicine, former President of the North Carolina Integrative
Medicine Society, and a member of North Carolina’s Vector Disease Task
Force. Mark N. Mead, MSc, is a nutrition educator and research
consultant. For more information about the Carolina Center, call (919)
571-4391 or visit www.carolinacenter.com

Are you taking handfuls of supplements? You might wanna think about
what you’re doing if you’re in the habit of doing that. Timing of
supplement intake is as important as the form in which you take them.
That would have to be a totally different discussion altogether though.
For now, let’s discuss ways in which to optimize the effectiveness of
your nutritional supplement program. One thing to take note though
before I make general recommendations is that everybody is
metabolically different and unique and as such, an individualized
program has to be in order.

Multivitamins, whole-food based, should be taken with food a couple
of times a day. I’m not a huge fan of time-released multis because they
usually come in the form of tablets (which by the way, may have
unnecessary binders and fillers).

Probiotics ideally, are taken on an empty stomach unless they’re enteric-coated.

Supplements such as essential fatty acids and fat-soluble vitamins
like vitamins A, D, E and K are best taken with the heaviest meals.

Mineral supplements are taken apart from meals since fiber from food would actually interfere with their absorption.

Amino acids should ideally be taken apart from food as well. Examples include NAC, L-carnitine and L-tryptophan.

Digestive enzymes such as pancreatic enzymes should be taken 15-30 minutes prior to meals.

Plant-based enzymes such as bromelain and papain are more stable in an acid environment and as such, can be taken with meals.

I’m available for in person and virtual consultations. Contact me at
+1-415-800-3757 or on Skype at drjlopezmd. Yours in wellness, DrJLo.
www.drjlopez.com

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Perhaps you have a
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Prenatal care from a conventional medicine perspective follows a
standard that is an excellent starting point. Tobacco and alcohol
restriction, measuring iron levels, checking fetal structural
development, BP and urine measurements, and other aspects of primary
care prenatally are important pillars. With more funding, and if asked
to direct a higher standard of care, these are the additional
recommendations I would make:

1. Disseminate information to would-be parents,prior to conception, that a pre-pregnancy session with a trained professional is advisable.

2.
During the pre-pregnancy session, an individualized treatment plan
would be outlined by a holistic professional, with the intention of optimizing mom's health.
This session could be used to understand Mom's lifetime habits and
exposures, address nutrition imbalances, optimize liver function,
provide support for digestive and intestinal health, and detoxify
tissues following the principles of functional medicine. Setting the
target date for conception based on a measurable change in Mom's health
would be advised. (The same process can be used for Dad based on
research indicating the importance of sperm health.http://www.ivf.net/ivf/sperm-damage-can-be-passed-to-children-o3239.html)

3. During the pre-pregnancy session, a discussion would take place emphasizing the importance of: a balanced diet;
the avoidance of dietary chemicals like high fructose corn syrup, MSG
and aspartame; assessment and avoidance of food allergies, intolerances
or sensitivities; organic food choices with direction on avoiding "the
dirty dozen"http://bit.ly/ltSaBM; the best fish choiceshttp://bit.ly/Q5mC3; and the basics of hydration including the healthiest water sources.

4. A home survey would
be conducted, with education about: the importance of avoiding home
renovation projects during, and perhaps prior to, pregnancy; cleaning up
indoor air quality; the common sources of household leadhttp://1.usa.gov/lj9KsB; and the strict avoidance of chemicals like pesticides. Scanning the home for EMF's and geopathic stress could be included.

5. Aworkplace survey would
be included as well, again with the purpose of identifying and
avoiding sources of poor air quality, excessive radiation, and
oxidative stressors.

6. Provide sound advice about dental procedures and cleaning during pregnancy where amalgam fillings are involved.

11.
Instruction on appropriate physical activity, air travel, emotional
stress and other impactful daily activities that are often taken for
granted.

This is a list that can be expanded as research develops
regarding how to best protect a developing fetus from any negative
influence of environmental and nutrition factors. It is based on
personal experience in my medical practice where taking detailed case
histories, including pregnancy exposures, of a tremendous number of
families has been part of my daily routine for over 10 years.

The
goal is ensuring the healthiest newborns and children possible,
understanding that studies have shown that at birth 287 chemicals have
been found in cord bloodhttp://bit.ly/pIsyQ.
For some children, perhaps the ones with susceptibilities or
compromised nutrition, a chemicalized start to life inside, and then
outside, the uterus is a contributing factor in developmental disorders.

Parents
are advised to bear in mind that fetal tissue concentrates many
chemicals to a much higher level than what exists in Mom's tissues, that
many chemicals move to the baby from Mom during pregnancy, and that
the blood-brain barrier is not fully developed until at least 6 weeks after birth.
A little education in this area can go a long way, which in my mind
should begin prior to conception. Because the question needs to be
asked: are we as a society, in the 21st century, doing all we can to
ensure a healthier start for our newborns?

Approximately 83 percent of people with cancer use at least one complementary and alternative medicine (CAM) modality (11).

Using my experience as a health and wellness expert, I have compiled a list of what cancer patients say about the choices they make regarding cancer treatment:

To be proactive, to take control, to take charge of decisions that affect my care, my health, my experience, my results and outcomes.

To participate in my own care and my own decisions rather than giving power to make all decisions away to my care providers.

To feel a sense of empowerment rather than be disenfranchised and disempowered.

To decrease and manage my fear, stress and anxiety and to support, increase and improve my peace of mind.

To ask my care providers to work with me as a team and to show respect for my values, my feelings and my choices in all decisions.

I choose to reject an approach based solely on a 'war on cancer' that only targets my cancer tumor cells and neglects the whole person and the environment.

I choose a comprehensive care approach using a wide range of therapies, tools and resources from many traditions and many points of view.

I choose individualized and targeted care which views me and my cancer as unique and in which decisions and choices are based on a careful analysis of the traits and characteristics of my cancer cells and my unique physiology, genetics and risk factors rather than a generic one size fits all approach.

To actively manage and reduce both short term and long term toxic side effects from conventional cancer treatments such as surgery, chemotherapy, radiation therapy, hormones and other drugs used by oncologists, radiologists and surgeons.

To utilize integrative cancer care and alternative treatments when the conventional oncology treatment offered to me is perceived as worse than the disease itself.

To utilize integrative cancer care when there are no conventional oncology treatments that offer me a therapeutic benefit.

To utilize integrative oncology care when the known risks of conventional oncology treatments are greater than the known benefits of those treatments.

To utilize integrative cancer and alternatives to conventional care and to use integrative cancer care without conventional oncology treatments when there are no effective conventional cancer treatments recommended or available to me.

I have fundamental confidence in the value and benefits of integrative cancer treatments that address the whole person and have my health, recovery, survival, quality of life and peace of mind (not just absence of disease) as both a short term and a long term goal.

Choosing an integrative cancer care approach makes a significant difference for each unique individual cancer patient. In this model, the patient is a fully empowered participant in making decisions and choices related to their cancer treatment, cancer recovery and cancer survivorship in concert with their team of care providers.

This is the goal of evidence based, compassionate person centered health care: combining the best of science and nature, modern knowledge and ancient healing wisdom, in order to transform disease, restore healthy function, wholeness and quality of life to each unique individual patient.

Rather than a model focused primarily on disease management, this is a model which also includes health, healing and the whole person as well as the internal and external environments of each unique individual to form a matrix in which the continuum of health and disease can be more fully met and understood.

When a health care model includes not only disease management, but also restored health and function, different choices are made by both patients and care providers.

Even if the disease is not eradicated and recovery is not possible, healing and wholeness may still unfold. Even in terminal illness, when compassionate care becomes the primary care, the patient can achieve integration of the experience and a capacity to face the end of life and make peace with what is so.

If you watched Dateline's interview with Suzanne Somers and are wondering about ACAM's position on alternative approaches to cancer treatment, this video outlines the basic differences between integrative and alternative medicine.

Are mercury, lead, and other toxic metals likely culprits in classic autism, ADHD, Asperger Syndrome, and other Autism Spectrum Disorders (ASDs)? Can yeast overgrowth and intestinal imbalances have a substantial impact on many ASDs? Do kids with ASDs often suffer from an inability to detoxify toxic compounds? Can these children benefit from therapies aimed at removing these toxic factors and correcting the underlying biological problems?

The answer to all these questions, based on our clinical experiences and training at the Autism Research Institute, is a resounding yes. But if this is the case, why is there so much disagreement among pediatricians and public health scientists? The reason: Much of the population-based research to date has focused on the more superficial aspects of ASDs, and in doing so has helped engender the misunderstanding that such toxic factors as mercury and fungal toxins are of little relevance to the child with autism.

Of Detox Defects and Vulnerable Brains

A recent study, published in a 2010 issue of Acta Neurobiologiae Experimentalis, found that individuals diagnosed with ASD had blood mercury levels that were approximately double those observed in non-ASD individuals. However, closer examination of the data revealed a threshold blood mercury level below which no autism was seen. Specifically, the total blood mercury level did not increase the odds of having autism until it was greater than 26 nmol/L (>5.2 μg/L). Individuals with a blood level higher than 26 nmol/L were three times more likely to be diagnosed with autism than individuals whose blood level was lower than 26 nmol/L.

These findings, which come from the Institute of Chronic Illnesses, Inc., in Silver Spring, Maryland, are consistent with multiple studies showing increased levels of mercury in the teeth and brains of children diagnosed with an ASD relative to non-ASD kids. Several studies also found increased mercury in the urine and fecal samples following chelation therapy, as well as associated urinary porphyrins among ASD individuals relative to the control groups. Moreover, a 2009 report in the Journal of Toxicology demonstrated a strong relationship between the severity of autism and the relative body burden of toxic metals.

Now, some scientists may reasonably argue that blood mercury levels are not consistently linked with ASDs, and they would be correct. However, blood mercury levels do not reflect chronic exposures or tissue levels—only acute exposures, for example, from industrial accidents, eating mercury-laden fish, or off-gassing from dental amalgams. The metals that accumulate from pre- and post-natal exposure are not reliably detected by a blood test, only by a combination of urinary porphyrins and urinary mercury following administration of metal-binding agents. Doctors who have studied heavy metal toxicology understand this.

Also seemingly paradoxical is the finding of lower hair levels of mercury in very young children with ASDs. This suggests that ASD kids are unable to excrete the mercury that has accumulated in their bodies. Indeed, we find that virtually all children with autism show measurable defects in their detoxifying capacity. These defects render the children unable to eliminate or neutralize many brain-toxic factors such as lead, mercury, and pesticides—and more prone to the brain-injuring effects of inflammation and oxidative stress. Many of these kids also have immune system imbalances that keep ther brains inflammed as well as rendering them even more susceptible to harmful bacteria and other microbes and their toxins.

The implications of this complex profile of susceptibility are profound. These children are like the proverbial “canaries in the coal mine”—far more vulnerable to the pollutants that other children’s bodies handle with ease. If you’re not taking into account the detoxification and immunologic problems commonly found in autistic children, then population-based comparisons of exposure levels have less relevance.

Deficiencies in key nutrients and metabolites that support detoxification pathways also are extremely common among children with ASDs. For example, many of these kids show low glutathione or its metabolites in their blood and urine. Since glutathione is the core detoxifying molecule in our cells, this deficiency greatly limits the child’s ability to process and eliminate mercury and other toxicants from the blood. Those children who are genetically less capable of detoxification, or whose detox mechanisms are overwhelmed with other toxins, are far more prone to toxic overload—and thus to the neurologic and behavioral problems linked with ASDs.

Developmental Delay or True Treatment Effect?

Another common criticism you will hear of doctors who are using this innovative approach is that autism is a condition of developmental delay, and that at least some of these children—possibly 5 to 19 percent—will go on to develop and function fairly well. Without conducting randomized controlled trials, these critics say, you never can know whether the development and improvement of symptoms would have occurred anyway with time, or whether the improvement could simply be attributed to behavioral and occupational therapy.

Going further, the critics contend that the single-person level of observation can be very deceiving, and that you can easily be fooled into believing that what you are observing is a real benefit versus something that might have happened by chance.

Here’s the main problem with this view, and perhaps the most profound myth-busting truth of all. You cannot be fooled by what you’re seeing when improvements occur on the integrative treatment program, and then those same improvements vanish if the child goes off the program. If your child quickly gets worse every time they go off their program, and then improves again every time they go back on, this is clearly due to the treatment. This is what separates clinical trials from case-by-case observations in the clinical setting, and it is incredibly important in the context of ASDs, since every case is so different and requires a high degree of individual tailoring based on testing results.

Let’s take the example of intestinal candidiasis, or yeast overgrowth. When children with ASDs are treated for an obvious yeast overgrowth, at some point they begin to show a dramatic improvement in their behavior—showing great eye contact, communicating well or even animatedly, becoming more peaceful and attentive. When they go off the anti-yeast treatment, their behavior can spin wildly out of control again.

Another example: Many children are sensitive to gluten. Take them off gluten-containing foods for three weeks, then reintroduce those foods and watch what happens. Very often there will be some improvement in behavior during the time off gluten, but if the child has an underlying intestinal infection or yeast overgrowth situation, that must be resolved first.

Our approach at the Carolina Center for Integrative Medicine addresses the problems that are common to virtually all children with ASDs, including detoxification weaknesses, toxic overload, nutritional deficiencies, and intestinal imbalances such as yeast overgrowth. Various nutrient deficiencies have been documented in children with ASDs, and targeted nutritional strategies are often very helpful and again make other strategies more effective. In addition, we help identify certain “trigger” foods, such as casein-containing dairy products, wheat and other gluten sources, sugar, chocolate, preservatives, and food colorings.

As implied in the mention of gluten and yeast (see above), proper sequencing of the treatments is part of the art of medicine when it comes to helping kids with ASDs. For example, the full benefits from heavy metal detoxification and hyperbaric therapy (pressurized oxygen) are only likely to occur when the GI tract problems are addressed first. Children undergoing this integrative approach may show rapid improvement in language and social skills, as well as better sleep, moods, and overall disposition.

The medical-scientific community is beginning to wake up to the power of this perspective. In November 2009, the American Academy of Pediatrics, Autism Speaks, and the North America Society for Pediatric Gastroenterology, Hepatology and Nutrition, hosted a symposium of researchers and physicians to address GI problems seen in children with ASDs. The symposium was intended to raise awareness among specialists about GI disorders in autism and to educate doctors about new treatment strategies for ASDs.

Overcoming Autism: A Success Story

When it comes to harnessing the power of this integrative approach, one of the keys to therapeutic success is catching ASDs at an early age, when there is still sufficient neuro-plasticity or brain plasticity. The term plasticity refers to the central nervous system’s ability to change neurons and neuronal pathways, and ultimately to re-organize entire neural networks. A good example of this early-life therapeutic advantage is the story Mike Simpson, now age 5, who was diagnosed in November 2006 with autism. At the time of his diagnosis, several physicians had told Mike’s parents, John and Suki Simpson, that no treatment options existed and that recovery was impossible.

Mike’s pediatrician referred the parents to the state’s behavioral intervention program. Although they found the program somewhat helpful, it clearly was only a start, and his behavior remained that of a child with classic autistic disorder. “At the time, Mike did not respond to his own name,” Suki Simpson recalls. “He was unable to sit in a chair or by a table, and he could not focus on any activity for any extended period of time.” Due to these limitations, it seemed unlikely that he could reasonably benefit from the behavioral program.

In his first year of life, Mike appeared to be deaf because he would not respond to his name, nor did he react to loud noises, such as the doorbell ringing or a car horn honking. Testing revealed that his hearing was fine. In fact, as the parents later learned, Mike was quite sensitive to sound—but was not responding because he was tuning the sound out due to the pain it caused. This phenomenon is fairly typical among children with autism.

One glance at Mike’s diet at the time might have provided some insight into his behavioral issues. From the moment he began eating solid foods, according to the Simpson parents, he seemed to constantly crave carbohydrate items such as crackers, pizza, chicken nuggets and Cheerios. His diet as a whole was quite limited, and he invariably shunned new foods. The parents began to wonder whether his diet might have something to do with the abnormal behaviors he was exhibiting.

“We began to speculate about how nutrition could be impacting Mike’s body and mind,” says John Simpson. “Perhaps his limited diet was giving him headaches, or perhaps he lacked the nutrition needed for normal brain function. Perhaps he was unable to sleep because his stomach was upset, or he was not eating well because the food did not taste good to him. These kinds of questions prompted us to begin looking into alternative approaches to autism.” As the parents looked further, they came to believe that a “leaky gut” and possibly other digestive problems, along with poor nutrition, could be fueling Mike’s abnormal behaviors.

When Mike turned age two in the spring of 2007, the parents placed him on a gluten-free, casein-free (GFCF) diet—a diet free of cow’s milk, wheat and most other grain products. “Immediately, we saw several of his behaviors improve,” Suki Simpson says. “Soon afterward, we added digestive enzymes as supplements to his diet six months later. This led to small but continual improvements in his focus and communication, including his very first ‘Mama.’ That was immensely exciting. We realized then that there had to be an underlying biological reason for his behavioral symptoms.”

In December 2007, after an Internet search of physicians listed in the Defeat Autism Now! (DAN!) directory, the parents sought my expertise and scheduled an office visit with me at the Raleigh-based Carolina Center for Integrative Medicine. (Much of the Carolina Center’s approach to autism is adapted from the DAN! program. To help decide which supplements and which parts of the program to emphasize, we recommend individualized, in-depth clinical and laboratory testing.)

After an extensive evaluation that included laboratory testing to look for signs or markers of hidden infection, I determined that Mike had an overgrowth of Candida yeast and bacteria in his intestines. The first treatment priority was to reduce the yeast levels in order to improve his digestive function health. In addition to pharmaceutical and herbal anti-fungals, Mike received specific supplements aimed at killing disease-causing organisms, as well as replacing those microbes with beneficial bacteria.

Our second effort was targeted towards vitamins and other nutrients his body lacked, and were intended to help him feel and function normally. At the same time, the parents also elected to have him start hyperbaric therapy, involving the use of pressurized oxygen to activate neurons in his brain. Children undergoing hyperbaric therapy often show rapid progression in language skills and the expansion of their vocabulary, as well as a range of behavioral improvements. Later in his treatment, Mike received an antiviral medication called Valtrex, which is thought to work as a brain anti-inflammatory agent. Recent research, all published in peer-review medical journals, has highlighted the benefits of this integrative medical approach. For some excellent summaries of this research, see the August and December 2002 issues of Alternative Medicine Review, as well as the February 2008 Journal of Alternative & Complementary Medicine.

The multi-pronged treatment—including anti-microbial therapy, physiological rehabilitation, and nutritional and behavioral interventions—led to rapid and dramatic improvements. Within four months, Mike not only knew his own name and made good eye contact, he also began speaking the name of everyone with whom he was coming into contact on a daily basis. He could speak in full sentences and quickly developed a huge vocabulary. He could count to 40, and his ability to recite the alphabet, identify letters, and put letters together was that of a first grader. To his parents’ delight, Mike became very sociable, talkative and interactive, singing songs and playing games like tag and Hide-and-Seek. He made friends easily at school, and it was very clear to his teachers that he had a keen ability to learn.

“If we had not seen it happen before our own eyes, we would not have believed it to be possible,” says Suki Simpson. “Recovery from autism is possible. In the beginning, teaching Mike was like driving down a dead end street. Today, we are cruising along a highway with interaction in both directions.” Suki adds that Mike has been thriving both socially and intellectually in a mainstream classroom at their local elementary school. “He has lots of friends,” she says. “And he talks with them and us all the time. We couldn’t be happier with his complete turnaround, and for that, we give credit to the Carolina Center’s approach.”

In short, there is now light at the end of the tunnel. At this writing, we have seen hundreds of children with ASDs go from having all types of aberrant behaviors to becoming playful, sociable, and communicative. Many of them have gone from extreme isolation to being mainstreamed in a normal school, performing just as well as their peers, sometimes even ending up at the top of their class. Yes, behavioral interventions such as speech therapy, occupational therapy, and Applied Behavior Analysis still have an integral role to play, but very often the results they achieve are limited. By addressing the underlying biological issues, autism and other ASDs can be greatly improved. And in some cases, as we saw with young Mike Simpson, autism and ASD symptoms may disappear altogether.

John C. Pittman, MD, is the Medical Director of the Carolina Center for Integrative Medicine in Raleigh, NC, and is certified by the American Board of Clinical Metal Toxicology. Mark N. Mead, MSc, serves as the Center’s Nutrition Educator and Integrative Medicine Research Consultant.

Integrated Medicine for Neurologic Disorders is a book which addresses herbal and holistic medicine for brain health and neurological disorders such as Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis, Stroke, Migraine, and Seizures. This book can help patients and medical practitioners to integrate Western medicine with herbal and holistic medicine to reduce symptoms and slow disease progression.

Sheryl Shook, Ph.D., a physiology professor with a Ph.D. in neuroscience, co-authored the book with Dr. Sidney Kurn. They have combined their expertise to work in the community educating about improving health by integrating the benefits of mainstream medicine with the rich and valuable practices from many cultures that rely on plants, nutrition, and lifestyle for healing.

“Keeping your body healthy is an expression of gratitude to the whole cosmos - the trees, the clouds, everything.” Thich Nhat Hanh

As one of the oldest medical subspecialties, neurology has a long history of clinical observation and theoretical development. The extreme complexity and inaccessibility of the nervous system continues to challenge researchers, compared with the rapid, technological development of other specialties such as cardiology or nephrology. Until the last 20 years, even drug treatments were rather limited. Neurologists have witnessed a rapid growth in our pharmacopoeia, including drugs for disorders previously untreatable such as ALS and Alzheimer’s disease.

Most exciting is the seminal breakthrough in seeing an underlying order involving a few abnormal processes that manifest variably as Parkinson’s disease in one patient, Alzheimer’s disease in another, and so on. Numerous articles report on studies revealing inflammation, excitotoxicity, oxidation, genetic predilection, nutrient deficiencies and environmental toxicity in the onset and development of neurologic disorders. Disorders as disparate as stroke and multiple sclerosis, share these underlying processes. The contribution of each process, the particular positive feedback loops, and particularly the genetic predilection appear to determine the particular disease in any one individual. Even the fields of neuroprotection and system theory, generally not part of mainstream neurology, are receiving attention with numerous articles in peer-reviewed journals (1).

Unfortunately, despite these important developments in clinical neuroscience, patients continue to suffer the symptoms of neurologic illness. Our drugs are not as effective as we would like, illnesses continue to progress, and the chronicity of some diseases overwhelm our best efforts. As patients and clinicians, we are committed to being pragmatic, finding what works, even if usage is based on tradition without good double-blind, placebo-controlled trials. Large randomized trials are expensive, and for natural herbs and nutrients, do not necessarily lead to a patentable product. Numerous studies on supplements exist and appear regularly in peer-reviewed journals. Studies may not rise to the level of large randomized trials necessary for FDA approval. The absence of this type of evidence is not proof of lack of efficacy. In regards to toxicity, the long history of usage provides ample information, and new interactions are reported on a regular basis. The “gold standard” of clinical drug usage, the Physician’s Desk Reference (PDR), has its second addition on herbs and nutrients. The standard pharmacist’s reference on herbs, nutrients and their interactions has also been re-edited. These texts, plus innumerable Medline references help guide the judicious use of supplements in clinical practice, or, what I call, clinical supplementation.

Integrated Neurology is the practice of neurology utilizing all appropriate measures to alleviate suffering in an individual patient with a neurologic disorder. This may involve drugs, herbs, nutrients, acupuncture and a large group of bodywork modalities. It is an “open system”, drawing information as needed from science, medicine and the more traditional healing arts. It is “evidence based”, from large randomized trials, millennial long traditional usage as well as anecdotal evidence. The principle of “do no harm”, applies to Integrated Neurology as it does to medicine in general. Even though herbs and nutrients are generally much less toxic than drugs, known side effects, toxicities and drug interactions exist and require careful consideration. Integratedneurology.net offers the reader an introduction to Integrated Neurology including basic principles, treatment suggestions, references and appropriate linkages. Feedback is welcome on the E-mail site.

Get to know ACAM member Stuart H. Freedenfeld, MD, and his passion for Integrative Medicine in his essay, My Path to Integrative Medicine.

I was a rebellious youth, born in the forties and inspired by the awareness movements of the sixties. Having aspired to scientific research since my earliest memories, it was during my last year in college that I shifted focus and came to know that my passion was to devote my life to the healing profession. Having excelled in high school and college, I felt drawn to the more glorious pursuits of the surgical subspecialties especially neurosurgery. While working in the inner city free clinics, which are training centers where inexperienced doctors-in-training practice their new skills on the areas poor and uninsured, I realized that my inspiration came from the people that I served and not from the skills that I had to offer them. Family Practice seemed the only area where I could devote myself to the patient rather than the procedure.

After completing my residency in Family Practice, I entered private practice with Kirk Seaton, MD, who had been the director of the Phillips Barber Family Health Center where I had trained. Together we formed Stockton Family Practice. After only two years he decided to return to academic medicine. For the next four years I was the solo physician at SFP. I worked six days per week including two evenings and every Saturday. I was taking call and even delivering babies seven days per week, fifty-two weeks per year. I still get excited with the memories of delivering over 500 babies during my medical career and am thrilled to have been present at the beginnings of so many new families.

These were exhausting years. So when Sal D'Angio knocked on my office door saying he was just finishing his residency training and wondered if I would consider letting him join SFP, I was more than eager to learn about this new physician. He told me about his background and how he had also studied homeopathy, acupuncture and herbal medicine. It intrigued me as it was a far different medical experience than I had had.

Medical school is a place for learning, but it is also a place for conforming. My training had not expanded my horizons, rather it had narrowed my focus. Now this new doctor reinvigorated my passion for learning and my natural tendency to think outside the box. We established a collaborative relationship as we each learned what the other had to offer. But this was not easy for me. Sal understood and taught his skills in ethereal terms but I was a scientist at heart and needed to understand healing in biochemical terms. In a sense, my early studies in these "alternative" approaches were like studying poetry in a foreign language in which I had only limited knowledge. I could say the words but could not grasp the intricacies of meaning. I could see that alternative therapies worked but I could not relate to them in terms that made sense to me.

My great awakening occurred in 1989. Three of my patients in one year had very poor outcomes related to conventional treatments for their coronary artery disease. One 54 year old died during the angiogram study, another died immediately after his bypass surgery and the third, a 79 year old woman had successful bypass but suffered terribly for a year with various complications. None of these individuals had severe symptoms and none had immediately life threatening disease, but each one suffered from standard medical care. I felt obligated to learn more about alternatives. I had heard about chelation therapy for cardiovascular disease but had no personal experience so I went to a 5-day conference on chelation and other aspects of complimentary medicine sponsored by ACAM (The American College for Advancement in Medicine).

I was blown away. Not only was there science behind chelation, but I found myself at a conference taught by world leading scientists, discussing their own particular area of research. Until then, all medical conferences that I had attended were taught by doctors discussing pharmaceutical treatments and presenting the research that was bought and paid for by the pharmaceutical industry. This same industry was also paying their speaker fees. How refreshing to hear information from people who held my own passion for research and shared their knowledge for the sake of healing rather for the sake of selling. Suddenly hawthorn, coenzyme Q 10, L-carnitine and magnesium took on whole different perspectives.

I was so overwhelmed with this abundance of information that I literally could not sleep for the entire five days of this conference. The speakers spoke of alternative medicine and they spoke in my own language, the language of science.

That five-day conference was my epiphany, Since then I have never lost my enthusiasm for learning or my zeal for the healing arts. In the years since 1989 I have continued to pursue knowledge for the sake of my patients with a driving passion that still gives me exhausted evenings and sleepless weekends. I wonder at the universe of knowledge and am humbled by the vastness of the unknown. My enthusiasm comes from the needs of symbiotic fashion, I am nourished by those that I nurture. I learn from those that I teach. I am healed by those I attend.

For the past 15 years Stockton Family Practice has been devoted to integrating the finest aspects of healing arts from around the world and throughout time. Our goal is to be able to provide the safest and most effective approaches to health and healing for those that come to learn and be well. There is no retirement from this pursuit, only gratification. And so to all of you who give me strength, I say thank you.

Dr. Freedenfeld is the medical director of Stockton Family Practice. He received his Bachelor of Science Degree with Distinction from the University of Rochester in 1970 and received his Medical Degree, with honors, from the College of Medicine and Dentistry of New Jersey in 1975.

He has become recognized as one of the leading experts on the integration of multiple forms of healing. He offers consultation on the most complex and challenging problems of our day. His forte is in the areas of autism, chronic fatigue, chronic pain, allergy, autoimmune disease, colitis, cancer, heart and cardiovascular diseases, diabetes, detoxification, longevity and health maintenance. He believes there is a vast array of routes to health and healing, and teaches the integration of the routes most appropriate to the individual.

For more information on Dr. Freedenfeld or the Stockton Family Practice, please visit www.stocktonfp.com